=====================================================
General NPI Number Information
=====================================================
NPI Number | 1902553977
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | BEST LIFE PSYCHOLOGICAL ASSOCIATES, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/09/2022
-----------------------------------------------------
Last Update Date | 03/09/2022
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6 BOWERS ST
-----------------------------------------------------
City | NEWTONVILLE
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02460-1903
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 724-822-0239
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 897 WASHINGTON ST UNIT 600301
-----------------------------------------------------
City | NEWTON
-----------------------------------------------------
State | MA
-----------------------------------------------------
Zip | 02460-6013
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone |
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PSYCHOLOGIST
-----------------------------------------------------
Name | DR. JENNIFER BENGER
-----------------------------------------------------
Credential | PSYD
-----------------------------------------------------
Telephone | 724-822-0239
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 103TC0700X
-----------------------------------------------------
Taxonomy Name | Clinical Psychologist
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------